Special considerations

Diagnosis

If MSM also collect anal and pharyngeal swab even if asymptomatic at these sites.

NAAT

Ano-rectal swab

If MSM, and patient declines anal examination or has no ano-rectal symptoms, instruct in

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

NAAT – Nucleic Acid Amplification Test FPU – First pass urine MSM – Men who have sex with men

Diagnosis in females

Test

Site/Specimen

Consideration

NAAT

Endocervical swab

Best test if examined

NAAT

Self-collected vaginal swab

If not examined

NAAT

FPU

Only if endocervical swab/self-collected vaginal swab cannot be taken e.g. after a hysterectomy. Not as sensitive as self-collected vaginal swab.

NAAT

Ano-rectal swab

If patient has had anal sex or has ano-rectal symptoms. If patient declines anal examination, instruct

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

Specimen collection

Clinician collected for NAAT/culture/microscopy

Urethral swabs for microscopy should be collected when the patient has not urinated for at least 1 hour and only if the patient has frank urethral discharge. Squeeze the urethra to express the discharge and collect on urethral swab. It is not necessary to insert the swab into the urethra.

Rectal swabs should be collected by inserting a sterile swab 2-4cms into the anal canal and moving the swab gently side to side for 10-20 seconds.

Pharyngeal swabs should be collected from the tonsils and oropharynx.

High vaginal swab of vaginal discharge smeared onto a glass slide, air dried and sent for microscopy. Swab inserted into transport medium for culture.

Self-collection of samples for NAAT testing

Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.

Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.

FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.

Click here for information on how to describe self-collection technique to a patient.

Management

Doxycycline 100mg PO, BD 7 days if asymptomatic, but 21 days if symptomatic (see ano-rectal syndromes)

Azithromycin 1g PO, stat, and repeat in 1 week

Treatment advice

Treat immediately if high index of suspicion. If urethritis symptoms use Doxycycline while awaiting test results (See NSU) or if contact of index case use either Azithromycin or Doxycycline depending on assessment of adherence or patient preference

Start treatment for patient and sexual partner(s) without waiting for lab results.

Use azithromycin as the principle treatment option when nursing administered standing orders available.

If a patient has an intrauterine device (IUD), leave IUD in place and treat as recommended. Seek specialist advice as needed.

Follow up

Confirm patient adherence with treatment and assess for symptom resolution.

Confirm contact tracing procedures have been undertaken or offer more contact tracing support.

Provide further sexual health education and prevention counselling.

Test of Cure (TOC)

Not routinely recommended, unless in the following groups:

Pregnant women

Rectal chlamydia

TOC by Nucleic Acid Amplification Test (NAAT) in these situations should be performed at least 4 weeks after treatment is completed. An earlier TOC could yield a false positive result due to the presence of chlamydia DNA remnants.

Retesting

Re-infection is common

Re-testing at 3 months is recommended, to detect re-infection.

Consider testing for other STIs, if not undertaken at first presentation, or retesting post the window period.

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